Category Archives: Health Care

Fewer Children Seeking ER Treatment for Cannabis Ingestion

Cannabis-Related Pediatric Emergency Department Visits by Month. Source: Virginia Hospital Association

by James A. Bacon

The number of pediatric patients visiting hospital emergency rooms in cannabis-related incidents fell 21.5% in the first half of 2023 compared to the same period the year before, a decline that some attribute to bipartisan legislation regulating the production, sale, and potency of tetrahydrocannabinol (THC) in marijuana-related products.

A Virginia Hospital & Healthcare Association analysis shows that the volume of cannabis-related visits among pediatric patients had been trending higher over the past several years, peaking in late 2022 and early 2023 before dropping sharply in June 2023.

“This law was introduced to protect Virginia children and families from being harmed by ingesting unregulated, intoxicating products that can pose serious health risks,” said Delegate Terry Kilgore, R-Gate City, who sponsored the bill to regulate THC-infused products. “So, it is certainly welcome news to see that this policy change appears to be having a positive effect in terms of declining pediatric emergency department visits due to cannabis exposure.” Continue reading

We’re Doctors. Implicit Bias Training Has No Place in Medicine.

by Martin Caplan, MD, and Kenneth Lipstock, MD

Apparently, Virginia’s doctors and nurses are racist.

This is the message of two bills that are moving through the state legislature. The bills would force medical professionals to take ongoing “implicit bias training” to get and keep their license. The problem is that such training is insulting, dangerous, and scientifically indefensible. It’s grounded in the false idea that people mistreat and even oppress others, especially those of a different race.

It’s a popular narrative, but there is no sound evidence to support it. What is clear is that if our lawmakers pass these bills, they’ll encourage racial division and tribalism, while undermining the medical profession and hurting patients who need our help. Continue reading

Covid vs. Religious Freedom at UVA

by James A. Bacon

The University of Virginia has paid more than $1.8 million in legal fees fighting a lawsuit filed by UVA Health employees who were fired, despite religious objections, for refusing to take the Covid vaccine. And that’s just through November. Given the continuing litigation, billing has likely passed the $2 million mark.

Eleven former employees filed a lawsuit a year ago, claiming that the $3 billion-a-year-in-revenues health system arbitrarily declined to grant them religious exemptions from the vaccine mandate.

Hunton Andrews Kurth is the lead law firm for UVA, charging between $600 and $900 per hour for legal services and racking up $1.52 million in charges through November, according to documents The Jefferson Council has acquired through the Freedom of Information Act. Eckert Seamons has charged $240,000, and IslerDare $70,000. Continue reading

Public Health Covid Rules Were Nothing But Voodoo

Ralph Northam

by Kerry Dougherty 

We tried to tell you. Those of us with common sense were attacked for it though.

Back in 2020, when we were being accused of wanting to kill grandma because we knew the “rules” coming from our public health officials were — for lack of a better term — unconstitutional bullshit, we were voices in the wilderness.

Everywhere we looked, previously intelligent people were running around with silly bandanas on their faces — if they were crawling out from under their beds at all. They were acting like you had leprosy if you stood closer to them than six feet and they were begging the government to stomp on even more civil rights.

Their wishes came true. Most Americans complied with insane rules like wearing masks into restaurants, taking them off to eat, putting them on to walk to the restroom and taking them off when seated again.

Those of us who pointed out that it was as if the entire country was part of a silly SNL skit were vilified.

Continue reading

Slasher Ordered to Reimburse Medical Bills of his Victim

by Kerry Dougherty

Several things strike me about this crime and restitution story out of Patrick County.

First, after Larry Puckett nearly stabbed Justin Hawkes to death in the fall of 2019, Mr. Hawkes  incurred about $120,000 in medical bills.

Because the injured man was indigent, Medicaid stepped in and negotiated the price down to $22,000.

If this former English major’s math is correct that’s just under 20% of the original bill.

Does this suggest there’s some padding in medical bills? You bet it does. In fact, receiving any medical procedure is a lot like buying an airline ticket. Everyone on the flight pays a different amount for the privilege of squeezing into a tiny seat and arriving at the exact time. Some folks spent a fortune for their tickets. Others got a cut-rate price.

Same goes for medical bills, although many of those are accompanied by an emergency that leaves no time to shop around for a better price.

Face it, medical care is a racket. Dare to ask why that Tylenol they gave you in the hospital cost 15 bucks and you’ll get a verbal tsunami of indignation and gibberish. Just pay it, they say. You have insurance.

In this case, according to the Virginia Mercury, the judge ordered Larry Puckett to repay Medicaid for the injuries he inflicted on Mr. Hawkes once he completed his prison sentence:

Puckett was convicted by Patrick Circuit Court of malicious wounding. He was sentenced to 20 years in prison, with eight years suspended, and ordered to complete five years of probation and pay … the cost of the medical services as restitution. The restitution was to be paid in $50 increments each month following his release from prison.

I like it! Continue reading

The Impact of Virginia’s Certificate of Public Need Laws on Nursing Home and Home Health Care Availability and Expenditures

by James C. Sherlock

I have come across a major study in the National Institute of Health’s National Library of Medicine that made a point that I have not explored sufficiently to this point.

It discusses the intersection of nursing homes, home health care, CON laws like Virginia’s Certificate of Public Need (COPN) law, and Medicaid expenditures.

I have shown over time in a series of columns how bad many of Virginia’s nursing homes are.

Antitrust authorities at the Federal Trade Commission (FTC) and at the US Department of Justice (DOJ) have long taken the position that CON laws are anticompetitive.

This study, conducted prior to COVID, indicates that COPN administration will ensure that nursing facilities not only have little competition from other facilities, which it was designed to do, but also will limit home health care expansion, which the COPN law does not mention.

That is very good for the Virginia nursing home industry.

It is bad for every other Virginian, every one of whom may need at least post-operative recovery and rehabilitation if not long term care.

Some will need it in a dedicated facility, others can be better served at home.

The study indicated that COPN will tend to make home health care less available and potentially raise total Medicaid spending. It also showed that market forces unconstrained by CON laws like COPN will tend to reverse those trends.

So this article is dedicated to our politicians and their constituents.

You. Continue reading

National Academy of Sciences Offers Superb Recommendations for Fixing Virginia’s Nursing Home Crisis

by James C. Sherlock

Sometimes, we need to listen.

I just finished the 806-page 2022 report The National Imperative to Improve Nursing Home Quality: Honoring Our Commitment to Residents, Families, and Staff by the National Academy of Sciences (NAS). It is downloadable at the link.

That study and report were utterly professional and thorough, as scientific as you expect, remarkably staffed and bipartisan in recommendations.

I have compiled from Appendix D of that report those remedies recommended for execution by states and nursing homes. They deserve to be the centerpiece of Virginia law and regulation going forward.

All of them. Continue reading

The Virginia State Budget and the Rising Costs of Registered Nurses

by James C. Sherlock

I was asked yesterday by a reader about the relationship between nursing homes, rising registered nurse salaries and the new Virginia budget agreement.

Good questions. Virginia’s workforce includes nearly 70,000 registered nurses.

The state pays its workers, but it also pays its Medicaid share for private sector nurses. Pay for private sector workers is based upon market conditions. The market wage for registered nurses nationwide increased dramatically during COVID.

Perhaps the only good thing to come out of that mess was that registered nurses, of whom Virginia has 11% fewer than demand calculated by the federal Health Resources and Services Administration, got very large pay and bonus raises, and the new wage points appear to have stuck.

If the laws of economics work here, that will over time increase the number of nurses if we can educate and train them in the required numbers.

The latest figures from the Bureau of Labor Statistics for all states show that the median wage for an RN in Virginia was $79,700 a year. In Northern Virginia portion of the D.C. metro area, the median was $92,800.  The underlying data are a couple of years old.

Wages and bonuses can vary a lot among Virginia hospitals, nursing homes, home health agencies, nursing school staff and government employees, and are higher or lower depending on specialty. The private sector offers $10,000 to  $20,000 signing bonuses paid out after the first year.

Employers of course must pay payroll taxes and other expenses related to employees, and thus their costs will generally exceed $100,000 per RN.

Virginia RNs are still underpaid compared to national figures. The mean annual wage for America’s 3 million registered nurses in May was $89,010 compared to Virginia’s $79,900.

The federal Centers for Medicare/Medicaid Services, aware of some of the questionable business models of bad actors in the nursing home industry, published last week a proposed rule to both increase the minimum number of RNs in nursing facilities and to require all nursing facilities to reveal every year how much of the Medicare and Medicaid payouts go to salaries and related expenses.

So, Medicare and Medicaid costs will go up yet again. Continue reading

Virginia Has an Opportunity to Take the Lead in Nursing Home Technology Insertion to Improve Care with Existing Staff

by James C. Sherlock

A pending new federal rule defining strong nursing home staffing minimums has finally accomplished something that I thought unlikely in my lifetime.

It has in a single stroke aligned the interests of patients and their loved ones, nurses, nursing homes, state and federal governments, and taxpayers in finding ways to make existing nursing home staffs more efficient and effective.

That alignment brings the miracle of the loaves and fishes to mind.

It takes some explaining.

  1. The value of the new regulations to patients and loved ones and nurses is clear. Better quality of care for patients and better working conditions — less stress and better job satisfaction — for the nurses.
  2. The nursing homes and their lobbyists oppose the new rule, but it appears that it will happen. They face a significant shortage of registered nurses in Virginia and competition for nurses from hospitals with deeper pockets. So, they very much want to somehow reduce the new minimum federal requirements.
  3. The state and federal governments, and thus the taxpayers, will inevitably see demands for Medicare and Medicaid payment increases to pay for the new staff. So, it would benefit taxpayers and the national debt to reduce those ratios as long as the desired levels of care could be maintained.

One answer to address all of those interests is extensive automation of processes in which nurses are involved. Just some of the requirements:

  • Integrate electronic health records (EHR) and nurse support apps for real-time data entry on mobile devices;
  • Remotely pre-screen, prioritize and automate alert and alarm workflows;
  • Alert to medication administration requirements and help prevent medication errors;
  • Enable nurses to notify the appropriate responders to crises with one click on a mobile device.

Continue reading

An Overdue New Federal Rule to Improve Nursing Home Staffing

By James C. Sherlock

What would happen if the federal government were to propose for the first time specific nursing home staffing minimums?

We are about to find out.

A new rule.  A new federal proposed rule introduced yesterday has already survived fierce opposition from the industry, which tried to kill it in the womb.  They are not done opposing, but the administration seems to have its course set.

And the new rule is clearly within the letter and spirit of the Social Security Act that requires safe, quality care.

The new proposed federal rule consists of three core staffing proposals:

  1. minimum nurse staffing standards of 0.55 hours per resident day (HPRD) for Registered Nurses (RNs) and 2.45 HPRD for Nurse Aides (NAs);
  2. a requirement to have an RN onsite 24 hours a day, seven days a week (currently 8 hours a day); and
  3. enhanced facility assessment requirements.

While the final rule minimums will be phased in over a three-year period, five for rural facilities, they would, if in force today, render non-compliant 245 of the 281 Virginia nursing homes that are rated for staffing by CMS.

There are also groundbreaking provisions for transparency on the percentage of Medicare and Medicaid payments spent on direct care staff, not just for nursing homes but also for community and home care.

The new proposed rule is potentially a great improvement for prospective patients coming out of the hospital to recuperate and rehabilitate or entering long term care.

Which includes a lot of very vulnerable Virginians.

Continue reading

Who Knew?

Henrico Doctors Hospital courtesy HCA

by James C. Sherlock

I just came across a fact that surprised me considering how much I have studied Virginia hospitals.

Henrico Doctors’ Hospital with 767 beds and CJW Medical Center with 758 beds, both in Richmond, rank numbers five and six in size in the entire 180-hospital empire of HCA, the largest private hospital system in America.

Together they represent HCA’s largest market presence by far.

Go Richmond.

Virginia’s Certificate of Public Need Program – A New Sheriff in Town

by James C. Sherlock

Everywhere counterproductive to competition, innovation and cost, Virginia’s Certificate of Public Need (COPN) program also has proven antithetical to quality and safety in nursing homes.

A thorough 2022 report by the National Academies of Sciences, Engineering and Medicine on improving nursing home quality had this to say about state Certificate of Need (CON) programs:

Certificate-of-need regulations and construction moratoria do not appear to have had their intended effect of holding down Medicaid nursing home spending; rather, these laws can discourage innovation and decrease access.

Certificate-of-need regulations may contribute to the perpetuation of larger nursing homes.

Despite the prominent role of nursing home oversight and regulation, the evidence base for its effectiveness in ensuring a minimum standard of quality is relatively modest.

The role of Virginia’s COPN program is as counterproductive to nursing home quality as is imaginable. Remember, COPN decisions happen before the state and federal regulators of the operations of nursing homes even get into the game.

Virginia’s COPN program is a statutory incumbent protection regime across all of its regulated targets. But it has gotten especially bad results with nursing homes, which by nearly every measure are among the worst in America.

In Virginia, the only realistic way to increase the size of a nursing facility is by COPN approval of the transfer of beds from one facility to another, often from one region of the state to another. Continue reading

New Virginia Nursing Home Law Appears to Violate Federal Statute

by James C. Sherlock

In addition to the General Assembly embarrassing themselves in the way they passed a law on nursing homes in this year’s session, they did it in an unseemly rush.

There was no pre-filing, a near-immediate and disgraceful floor “debate” led by the nursing industry’s lobbyist, and a rushed vote in the House Health, Welfare and Institutions Committee.  

A committee member in the House hearing asked for time to consider the bill. Her request was denied by the Chairman, who was the House patron of the bill. That was followed by a cursory review in the Senate Education and Health Committee before near-unanimous passage by both bodies.

Now it appears that the new state law they passed may violate the governing federal statute. Which, of course, state laws are not permitted to do under the supremacy clause. Continue reading

The Ongoing Tragedy of Virginia’s Nursing Homes

by James C. Sherlock

Virginia’s Health Commissioners have a job that is broad and deep in its responsibilities and authorities.By statute, appointees must be physicians.

Each is the chief executive of the Virginia Department of Health (VDH): a central office in Richmond and 35 local health districts.

By Virginia statutes and regulations, they are also the final decision authorities on such issues as the licensing of hospitals and nursing homes and all Certificate of Public Need decisions.

Nursing homes. To the point of this particular discussion, Health Commissioners have since at least 1989 possessed statutory (Code of Virginia § 32.1-135) and regulatory 12VAC5-371-90. Administrative sanctions authority to sanction Virginia nursing homes.

B. The commissioner may impose such administrative sanctions or take such actions as are appropriate for violation of any of the standards or statutes or for abuse or neglect of persons in care. Such sanctions include:

  1. Restricting or prohibiting new admissions to any nursing facility;
  2. Petitioning the court to impose a civil penalty or to appoint a receiver, or both; or
  3. Revoking or suspending the license of a nursing facility.

The results of a FOIA request inform me that not one of them has ever used that authority.

Not once in 34 years. Continue reading

The Virginia Board of Health and Nursing Homes – A Strange Appointment

by James C. Sherlock

I am starting to lose my sense of humor about the whole Virginia nursing home thing.

The Virginia Board of Health (VBOH) writes state regulations for every health facility and health services provider in Virginia, including nursing homes.

There is a statutory seat on the VBOH for a nursing home representative. (Of course there is.)

The incumbent, appointed by Governor Northam, is Melissa Green, RN. I am sure she is a good nurse and a good person.

But Ms. Green is also one of the three founders and the Chief Clinical Officer (CCO) of Trio Healthcare.

Trio is rated by the Centers for Medicare and Medicaid Services (CMS) as one of the worst nursing home chains in the entire country and the worst in Virginia.

The senses of humor of all of us are once again threatened by The Virginia Way. Continue reading